I(x) Active TB Routine; FBE WCC (Infection) Hb (Anaemic of chronic disease) U&Es (baseline) LFTs (baseline) ESR/CRP (inflammation/infection)

I(x) Active PTB Diagnostic Chest X-Ray Abnormal CXR often found with no symptoms but reverse extremely rare PTB is unlikely in absence of radiographic abnormalities Exception is miliary TB or non-respiratory TB Findings Patchy or nodular shadows in the upper zones Loss of volume and fibrosis (with or without cavitation) Calcification may be present Similar CXR findings Histoplasmosis, fungal infections (cryptococcosis, coccidiomycosis, blastomycosis, aspergillosis), bronchial carcinoma, cavitating pulmonary Infarcts EVERY EFFORT MUST BE MADE TO OBTAIN MICROBIOLOGICAL EVIDENCE

A cavity is a walled hollow structure within the lungs. Diagnosis is aided by noting: wall thickness wall outline changes in the surrounding lung

I(x) Active TB Culture Clinical Samples sputum, pleura & pleural fluid, urine, pus, ascites, bone marrow, CSF Induce if non-productive (bronchoscopy & lavage) Prolonged culture – 12wks AFB – acid fast bacilli Ziehl-Neelsen stain Acid fast bacilli are stained bright red and stand out against a blue background Resistant to de-colouring when washed with acid

I(x) Active TB Other Imaging for non-respiratory TB (CT, XR etc) PCR – rapid identification of sensitivity/resistance (rifampicin) Biopsies – pleura, lymph nodes, solid lesions etc